Switching Hospital Systems to Linux

jcatcw writes "Health care software vendor McKesson Provider Technologies is focusing on ways to cut IT costs for customers, including hospitals and medical offices. The cure is moving many of McKesson's medical software applications to Linux, which can then be used on less expensive commodity hardware instead of expensive mainframes. A deal with Red Hat allows McKesson to offer its software in a top-to-bottom package for mission-critical hospital IT systems."

hmm

the cure are doing what now?

Re:

the cure are doing what now?

It looks like they're taking a 4 month break from touring, but they'll be back on the road in February!

http://www.thecure.com/events/default.asp?Year=Upcoming [thecure.com]

Re:hmm

The cure is moving many of McKesson's medical software applications to Linux

Monday, applications choke
Tuesday, Wednesday, RAID set's broke
Thursday, let out the magic smoke
but on Friday, I patch bugs

Monday, my xorg conf is toast
Tuesday, Wednesday, CPU roasts
Thursday, it won't even POST
but on Friday, I patch bugs

Re:LINUX IS FUCKING SHIT!!!

Don't kid yourself.

Java is "fully of weird mysteries" regardless of the platform.

Java app servers are plenty prone to crashing and eating up
all available memory. You don't need to run them on Linux for
that. AIX or Solaris will do equally well.

My guess is that they made changes without fully understanding
them or testing them. They disturbed their the little java
house of cards they had going.

Affordable health care

If this catches on, health care will become a little more affordable. 60% of IT costs is quite a bit of money for hospitals to save.

Re:Affordable health care

Honestly, it would be nice, but IT costs are afterthoughts when it comes to the healthcare industry. The market is so broken. Quality of care and price are completely detached. The privatization here, the socialization there... it's just one big quagmire. If this sort of thing did catch on, which would be a long ways in the future and a big if at that, the effect on the price of care would be almost unnoticeable. It's nice to dream, but beaureacracy and corporate litigiousness have busted the market. It's a mess.

Re:Affordable health care

Call me when we get doctors that are not gouging prices like crazy, hospital admins that do very little for their 6 figure incomes, Supplies that are horribly overpriced, medications that are priced 9000 percent higher than normal.

The entire medical biz is a scam to get the poor to finance a few $2,500,000 homes and lots of BMW 7 series cars. Doctors do not deserve to be paid insane rates. Some doctors are sane and charge real rates and tell their clients to avoid the hospital at all costs while helping them with outpaitent surgery in their offices.

IT costs are less than 1/90th the cost of health care.

Re:Affordable health care

The IT costs are peanuts compared to the real costs. And of course those real costs are mostly made up. It is the inflated values of machines used for testing. Any witch doctor can say your leg is broke, but only a few would have an X-ray and MRI machines to show why they need to charge you more for their opinion.

You would think that after they pay for their equipment, the costs of using it would go down. It just isn't so, Sure there are still costs like maintenance and so on but generally the cost of using it goes up once it is paid off.

Re:Affordable health care

They might be peanuts, but yet there tend to stack together pretty quickly. Just some months ago, I went to a talk about Open Source Course Management Systems where UKs MP Mr. John Pugh gave a very interesting talk. In one part of that talk he addressed the issue of the NHS (UK health system) upgrades to the doctors' machines. It seems, he argued, they were upgraded to new Microsoft Office software. But, when people tried to convince the NHS to use open source to reduce costs, they said that it was not possible because Microsoft was giving a "special edition" of Microsoft Office which was specifically created for Doctors. Pugh's comments were really funny and insightful, paraphrasing a lot, he said something like:

"So, what kind of 'special version' of word should a doctor need? do they come with special medical symbols? "

Oh well... I can not do sarcasm as well as a real Briton would do it... sorry.

Re:... and screw the economy

If that isn't the parable of the broken window if I have ever heard it! Efficiency to any market is a good thing. The more unnecessary cost involved in the healthcare industry, the more dollars it needlessly sucks out of the rest of the economy. Sure, you can make the argument that healthcare is a capital purchase in that it increases your viability in the labor force, but that is a stretch. Cutting bloat is never a bad thing. We need to cut some serious bloat out of the industry, and we should start with beaurecracy and go all the way down to reforming the insurance industry. There needs to be some kind of oversight on cost to quality ratios, as this hybrid government backed/privately funded monster is the model of inefficiency. I like to argue for social justice so I'm naturally wary of any solely private system, but a well-designed private system would be ten times better than what we have now.

Re:

I don't understand the mentality either. Once here on /. I simply stated that it might be a good idea for people to try to behave a bit more sustainably and I get ripped into about moving into a grass hut with a dirt floor. Consumption is a religion for some and it is due to a belief that the economy will collapse if we don't all go out and buy something and just throw it away unopened. Why would people think that?

Re:... and screw the economy

I don't understand the mentality either. Once here on /. I simply stated that it might be a good idea for people to try to behave a bit more sustainably and I get ripped into about moving into a grass hut with a dirt floor. Consumption is a religion for some and it is due to a belief that the economy will collapse if we don't all go out and buy something and just throw it away unopened. Why would people think that?

Social conditioning. The entire retail market is designed to make us aspire to the new stuff when the old stuff is perfectly adequate. This applies to consumer electronics, clothing, housing, etc. Its taken a while, but now many people are conditioned to confuse the words want and need.

If you ask why, or even worse, try to reduce your consumption, you are directly challenging the personal validation system of the more conformist consumers. If someone measures their self worth on the amount of money they earn, or the expensive toys they have, then you are questioning their status in the social pecking order.

Re:... and screw the economy

I think the market could find something much more efficient than health care that would more than offset the effect on the economy. Your argument reminds me of the broken window fallacy [wikipedia.org]. Wasting money in health care is like breaking windows and saying that it's providing jobs. Sure, but fixing that window is just taking resources away from better endeavors.

/br

Re:... and screw the economy

No, the spending wouldn't decrease at all. They would just reapportion the funds to equipment such as the latest digital X-Ray machines. Or the newest CAT scanner. Or the latest robotic surgical nurse.

You get the picture. In fact, in most of health care, that's just what happens already. They spend as little as possible on IT and reapportion the cost to areas of service that will directly benefit their ability to attract doctors and customers and therefore generate greater revenues.

Those reading this might think I'm kidding, but let me tell you this: I once replaced a token ring network with an ethernet network connecting Pentium IIs and IIIs. In 2005.

-- A former healthcare IT worker.

Re:

Those reading this might think I'm kidding, but let me tell you this: I once replaced a token ring network with an ethernet network connecting Pentium IIs and IIIs. In 2005.

Did the machines perform their allotted tasks adequately? Were the users frustrated or impeded by them? If not, then - baring malfunction - why replace them?

Re:Affordable health care

I'm in one of those scary, socialist countries - with a below-par-for-Europe health care system - and I got in with a broken arm, was X-rayed, and walked out with a cast the same day. Surgery was scheduled to readjust some bones that had grown at an angle a week later. This was a downtown health station, total cost $20. $30 if you count the burger we had across the street. (Ever tried to eat a large cheezburger with one hand? Non-trivial!)

But thinking about it, I guess you're right, these socialist countries suck. The game console they carted into my room while I was in the hospital was a stinkin' NES - now, come on. How rinky-dink and Soviet can you get? I wanted an N64, damnit!

/me wanders off, singing the Internationale

Lackluster vendor makes incremental, pitiful step

If you use McKesson's software every day like I do, you would be amazed at its expense, sluggishness, and irritability. Lab systems that insist on running on Internet Explorer 6 and resizing to fit your whole screen aren't a big surprise - however mediocre. But mission critical systems that routinely crash with Java errors, can't run reliably remotely, require large IT departments to maintain, are slower and more difficult to use than the tty-based systems they replaced, can't trend labs, can't reliably wildcard search patient names, and die miserably if the wind blows more than 5 miles an hour or the moon is waxing - this is truly sad.

I wish our hospital system could dig its way out of it. I don't think running on top of Linux will help much. See if you can get a screenshot of their software on their website - I can't - they don't promote this stuff to the physicians and nurses who use it - it gets sold to the suits. There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort, and though I love Linux, I don't really care what it runs on top of.

Re:Lackluster vendor makes incremental, pitiful st

Two possibilities: in the process of porting, they have to rewrite all of the bits that call grody Windows bits, such as IE, and therefore many problem bits get fixed . . . or they just write bad code all over again, Linux gets the blame, and hospitals revert at great cost.

RedHat may help though - they might insist on some level of quality / provide some assistance in the creation of software that does not suck quite so much. They have a reputation to maintain, as well as sufficient company-ness to expla

(laughs so hard milk squirts out his nose)

RedHat may help though - they might insist on some level of quality / provide some assistance in the creation of software that does not suck quite so much.

(laughs so hard milk squirts out his nose)

Red Hat newbie, are we?

Re:(laughs so hard milk squirts out his nose)

Gosh, I hope you were drinking milk.

Re:(laughs so hard milk squirts out his nose)

I actually think you're the redhat newbie and not the parent. RedHat in recent (3-4 years?) has been very stable. All the stuff gets seriously stress-tested on Fedora first, so by the time it makes it into a stable RedHat, things are stable--i.e. the packages don't "suck". Additionally, because things are "tested" on Fedora first you get this kind of intrinsic QA for things making it into RedHat stable. Next time you decide to squeeze milk through your sinuses, at least do it for something funnier ;-)

Re:(laughs so hard milk squirts out his nose)

Glad to see someone else saw this glaring piece of obviousness.

Just because a product wasn't plug-and-play in 1997 when you last used it, doesn't mean it still sucks a decade later.

The amount of testing/development that takes place in the fedora community all funnels directly into a more stable and usable product(i.e. RHEL). That subscription to RHN ensures those engineers bust their ass to fix whats wrong and get it delivered to you: it also means that if your the IT staff in said hospitable and something doesn't make 100%, you can call someone who it does make 100% to and get an answer/fix instead of diagnosing it for 45 minutes while a doctor needing to do a simple task breathes down your neck and wastes both their time and yours.

Re:

> Just because a product wasn't plug-and-play in 1997 when you last used it, doesn't mean it still sucks a decade later.

OBVIOUSLY you haven't been using Windows Vista.

Re:

Two possibilities: in the process of porting, they have to rewrite all of the bits that call grody Windows bits, such as IE, and therefore many problem bits get fixed . . . or they just write bad code all over again, Linux gets the blame, and hospitals revert at great cost.

You don't "call" IE, you serve it. And the description poster provided is of the Java server code rewrite that didn't work like the prior "tty" system. That's mainframe terminal software. (I'm an AS/400 System i pro

Re:Lackluster vendor makes incremental, pitiful st

Well, TFA didn't exactly mention it, but it appears that it's the server apps that get the UNIX -> Linux treatment. I'll bet that the clients remain XP / Exploder 5-6.

Linux at the desk top is so next year.

Re:Lackluster vendor makes incremental, pitiful st

AMEN BROTHER! I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial. I'm an anesthesiologist, so I see people I don't have long relationships with, and remembering someone's first name is just damned hard when you remember their medical conditions better than their name. The one piece of medical software I've seen that is really fantastic - and no, I don't own a piece of the company, I just wish I did - is our radiology system, Stentor iSite (now bought by Phillips, I think). It's very easy to use, yet the advanced user can access all sorts of features that improve the experience.

Re:Lackluster vendor makes incremental, pitiful st

I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial.

Pay attention here, IT freaks. Notice that the user here (possibly your doctor) says nothing about the OS. This is simply abysmal design and implementation. Unix/Linux/Windows/OSX/Oracle/Postgres/MySQL/MSSQL....ALL could end up thusly. Or all could end up not too bad. Design it right, and build it right. Think about what your user is actually trying to accomplish.

I saw some comments upthread about RedHat this and Linux that...Bullshit. The user interface is (most of) the key. If you screw that, the backend matters little.

Yes, if you start from a stable base, it is easier. But no matter what the base is, if you fuck up the actual program and interface the that user, in this case a doctor or nurse, uses....everything else is irrelevant. They will hate it. And still not care what the base OS is.

Re:Lackluster vendor makes incremental, pitiful st

Think about what your user is actually trying to accomplish.

But you missed the point in the grandparent posting -- this system is sold to the suits who run the hospital, not the poor sods who actually get to use it. As a result there is really no impetus for the management of the software company to spend anything more than the barest minimum they can get away with to actually develop the software or make sure it runs right.

I've been in this sort of situation (as a programmer) and I can say that it's not pleasant, nor conducive to good software development, usability, reliability etc.

Rich.

Re:Lackluster vendor makes incremental, pitiful st

There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort

This is exactly what I've been doing for the last 8 months. I'm being paid by a neurologist to develop a system to run his practice. What I've built is a LAMP framework that can be adapted to any medical practice. It's entirely paperless, replaces faxing, automates a ton of stuff currently done by secretaries, and meets all the requirements for electronic records set out by The College of Physicians and Surgeons of Ontario. I'm developing the whole thing on my own (so far), and although I'm not a brilliant programmer, it's faster, more secure, more scalable, and more platform independent, and way more intuitive than anything that's currently being used at any hospital in our city.

We're in beta testing with actual patients now and my boss is bankrolling us into starting a company to sell the software and other medical-related IT solutions to local doctors (many of whom have horribly inefficient offices and don't fully realize it). I'm hoping we can expand beyond just local doctors, because it is a huge market and the best anyone else seems to be doing (around southern Ontario at least) is holding seminars to talk about how technology could be used to enhance medical practice someday.

Re:Lackluster vendor makes incremental, pitiful st

yes its a huge market. it all works fine in a local institution, but the real challenge lies when you try to "generalize" it to different institutions, each with their own idiosyntric processes and data elements. Keep in mind unless you make the underlying engine some standards based (using RIM or terminology driven) or use good design software practices (Archetypes) you ll have a lot of trouble customizing it.. unless of course.. you become like existing vendors who develop the whole thing from scratch at each installation site and send a team of IT services who work there forever and keep your revenue stream running. Good Luck.

my 2 cents

Re:Lackluster vendor makes incremental, pitiful st

I was going to make my own McKesson sucks comment, but instead I'll just second yours. They write Crap. Period. End of story.

I remember sitting in on a presentation they once made to one of our directors regarding some new patient records management system they were trying to pitch to us. Not one single screen shot was shown nor were any technical people on hand so that I could ask the difficult questions. In the end, when she asked me my opinion, the conversation went like this:

Me: Remember application X that you used to use at hospital Y?
Her: Uh... yes.
Me: They wrote it.

We didn't buy the software.

Re:

Hospitals will not go for that.

They want accountability. They want someone to blame/sue if something goes wrong. A bunch of geeks writing software anonymously across the Internet? No hospital manager will go for that, especially with privacy guidelines going rampant. Even if they have the source code, they will not have the time/money to audit that code to make sure that everyone's info is not going to Russia.

They'll talk to Redhat and McKesson... Those companies are taking the responsibility (and liabi

Re:

They want accountability. They want someone to blame/sue if something goes wrong.

IMHO if they went this way the best option would be to hire a couple of really good programmers and get them to do the final QA on the code. Set down guidelines for the anonymous geeks out there and ignore code that breaches this. True this allows for winners of the underhanded C competition to have a crack at sneaking code into the system, but the accountability is there, and is thus no different from hiring a software company. The geeks benefit because at some point the cost of health care would surely d

Just wanna give a shout out to the PR rep...

Just wanna give a shout out to the PR rep that planted this story. Three brand mentions in the opening paragraph - can I get a whoop-whoop?

Two points off for the "less expensive commodity hardware instead of expensive mainframes" - that's a Microsoft marketing phrase from the early 1990's for God's sake - but still a pretty good job all around.

Dont make me laugh

A while ago I was hacking at parts of that great mess commonly known as McKessons "top-to-bottom package" for almost 5 years. As far as I can tell the "package" is actually hodge-podge collection of applications accumulated over time by acquiring various software vendors which barely talk to each other. In a lot of cases the people who wrote the apps and knew how to maintain those cached out and jumped the ship years ago. Last thing I heard of it this summer entire locations were shut down and routine maintenance moved to Bangalore. As a twist those left to the end had to do some time there training replacements. Personally I am extremely skeptical about their ability to maintain what's there, much less move this all stuff to radially different platform such as Linux.

OpenVista

Really want to save money? And a whole lot of Tums? Screw McKesson's kludgeware.

OpenVista is the open source version of the VA's VistA program, deployed at over 1500 sites worldwide. You can also grab it for free from http://sourceforge.net/projects/openvista [sourceforge.net].

Yes, you can get professional training, installation and ongoing support for it:

http://medsphere.org/ [medsphere.org]

Re:OpenVista

Are you actually using VistA in a medical practice? I hear a lot of people recommending VistA as a free software alternative to expensive and often disappointing commercial systems, but not many people use VistA outside the VA. I went to the WorldVistA conference in Pittsburgh in July 2006 to look into using it for our ~30 doctor ophthalmology group, and I was surprised at the small size of the community actually using this creaky old software in a private practice setting. There are a few promising installations, and the core user group is incredibly dedicated and friendly. I met one of the devs from MedSphere at another conference a couple years ago, and they've done some fascinating work trying to make the best of this system and support it. But I think most of the people recommending this system either don't know much about it or want you to buy their VistA related services.

I'm a pretty hardcore advocate of FOSS solutions, and I was excited by the hype around VistA. But after learning about this system in some detail there's no way I could recommend it as a reasonable alternative to the better commercial systems out there despite the savings on software licenses. MUMPS is a platform without much of a future. There are huge gaps in functionality. And the future of VistA outside the VA is far from certain. I'd encourage anyone looking for an EMR/EHR system to educate themselves about VistA a little, but I suspect most of them will reach the same conclusions we did.

OpenVista

OpenVista is an implementation of VistA as in Veterans Health Information Systems and Technology Architecture, which existed long before Microsoft Windows Vista, or any Microsoft Windows for that matter.

As Michael Bolton once said "No way. Why should I change? He's the one who sucks."

Posting as AC for obvious reasons...

Posting as AC for obvious reasons... Unfortunately for me I work in healthcare IT. But at least I can pass the bad news on to you.

We can argue about how much of healthcare costs are sucked up by IT. But whatever percentage you come up with is likely to be not insignificant. And one of the biggest costs of healthcare IT is the amount of money paid to so-called "IT Consultants".

My understanding is that pure healthcare people don't understand much about IT and since they figure IT is the next biggest thing, they are willing to give money hand over fist to people who have decent resumes in this field who present themselves as IT "experts".

They are throwing their money away. It's really awful.

If you don't believe me, look at some of the so-called IT "standards" documents coming out of the healthcare IT community.

Sure, HL7 V3 is a good, robust yet flexible standard definition. But look at some of the abysmal crap that is being built off of it.

I mean, seriously, read some of these "standards" documents coming from non-HL7 sources. Not only are they inconsistent with reality. They have massive internal contradictions, logical inconsistencies and even simple syntax errors. And this is stuff from organizations that have been around for A DECADE.

Believe me, IT consulting has nothing to do with helping the healthcare industry actually make the best use of modern technology and everything to do with lining the pockets of a few contractors who would be thrown out of any other domain for sheer incompetence.

Just make it work

I work in the Medical Imaging field, a MRI Field Engineer for Siemens, users in hospital want something that works, they are less tolerant of reboots and system hangs.
In the past Unix (SunOS) was the preferred platform, there are actually many MRI systems running on a 100Mhz Sparc processors today, which still do and excellent job.
We've moved to Windows, it's a common interface for users who can learn it quickly. Windows requires CPU's in the 3Ghz range and higher to be effective. Windows also has major issues with Service Patches and hotfixes in the Medical imaging world, all updates have to be QA'd so there is a delay of months before they get applied. Medical Imaging will probably continue to move away from Windows and it's patches if can make an interface easy for the average user who walks upto a system and start using it.
Recently at Siemens Medical http://www.siemensmedical.com/ [siemensmedical.com] the MRI systems moved from Windows to Linux (Suse) for the image reconstruction computers (Not at the user console). During MRI imaging data is coming in from the scanner at 10MSamples/Sec at 24bit accuracy up to 32 separate channels, that's a significant amount of data to be processed, having a mouse pointer and a GUI interface is just not needed, Linux just more efficient.

Bad idea

I don't know how big these customers are, but Linux is not as stable as people seem to think. I used to work for one of these software companies, and Linux was just for small customers (go above 1000 concurrent users and you're toast). Weird problems start to crop up. Usually RedHat will respond with oh just update to the latest version of xyz. But when you're talking about medical software you can't just upgrade things on a whim. Has RedHat's cluster software even gotten anywhere yet? That was another pain the ass to deal with.

It's Not a Mainframe

The original Computerworld article [computerworld.com] cited is confusing, but it refers to UNIX mainframes. The most likely educated guess is they're talking about high-end UNIX servers from Sun, Hewlett-Packard, and/or IBM, not what we would generally think of as true mainframes, notably IBM's System z [wikipedia.org].

Yes, among System z's five popular operating systems z/OS contains a complete and certified UNIX(TM) implementation (called z/OS UNIX System Services). And yes, System z runs 100% GPL open source kernel.org Linux. And yes, OpenSolaris on z will be z's OS #6 before too long, and that's clearly UNIX(TM) too. But I doubt the article is talking about any of these technologies, based on the context of the article. There are not 2,500 U.S. hospital IBM mainframes (the number of McKesson hospital customers cited), for example. Maybe there should be.

Computerworld's editors seem to be on vacation, unfortunately, so their usually good copy editing is suffering, resulting in some gibberish articles. This week they also reported that Steve Jobs and The Woz approached Commodore in 1982 to talk about the latter company selling the Apple II, pointing out that Apple's two founders didn't have enough money to launch the product, worked out of a basement, and the safety and stability of cashing out for a couple hundred Gs was better than the alternative. Unfortunately for Computerworld they got the date wrong: by 1982 Apple was doing just fine, and The Woz was doing Nissan commercials.

mainframe to windows

Usually what you see is people going from mainframe to windows servers(and expecting the same stability(ha)), so with that in mind, I am happy with the choice of Linux.

No!!!

Just what we need... MUMPS [wikipedia.org] for Linux. No!!!!!

Re:

dont underestimate the power of MUMPS. My advisor was one of the developers of the language (Octo's lab at Mass General).. sometimes during our meetings he pulls up the MUMPS command prompt and writes 2 lines to do stuff that would probably take me alteast 50 lines of Java code. seriously no joke. Someday I plan to learn it once he lets me graduate :)

Re:No!!!

well you are right but when you talk about the domain of healthcare or biomedicine in general, the complexity of data and processes is so high that to develop a software system you need "extra" data-structures/information models such as HL7 standards, ontologies etc. to meet the requirements of the application. So somehow I tend to think that X (health care domain-specific) language would a superset of a general purpose language that simply provide basic programming elements (say OO, loops, variables etc). Not sure about verbosity though.

In mathematical terms:

A = {basic set of programming artifacts}
B = {domain-specific structures and computable knowledge elements}

X = {A U B}
and Y = {A}

Re:No!!!

Big deal. A Hello World in Java takes up 50 lines of Java code.

public class YourWrong {
        public static void main(String args[]) {
                System.out.println("Hello Asshole. Yeah, this is 50 lines...");
        }
}


That's five lines...


$ wc -l YourWrong.java
5 YourWrong.java
$ javac YourWrong.java
$ java YourWrong
Hello Asshole. Yeah, this is 50 lines...

Re:

Linux is only secure if you have good people who know how to properly make it secure. It seems that there are a lot of shops where someone with a corner office and a nice car decides that linux is cheap and doesn't decide to properly staff for the change.

Re:Just watch

The janitor will come by, type a few random key strokes into the terminal, and boom, no more linux box. *nix computers are just too easy too kill.

Yeah, that's the major flaw of Unix operating systems, and it still hasn't been solved in the 35 years Unix has been around.

If only there was some sort of system under which some special user with special powers could create user accounts deprived of these special powers so that they wouldn't be able to break everything...